60 FOTHERGILL'S MEDICAL PAPERS CHAP. 



disorders his main remedy. It is the plethoric type of the 

 disease which he has in view, in persons who for the most 

 part seem to be in full health, who eat largely and often 

 incautiously ; if children they are highly indulged, or necessary 

 exercise is neglected. He therefore recommends in many 

 cases total abstinence from animal food and from fermented 

 liquors. A course of mild laxatives is to be given and steadily 

 continued, with a light chalybeate interposed ; riding, cold 

 bathing and general hygiene must be pursued with patience, 

 and these seldom fail of success ; small doses of opium only 

 when fright or pain have to be countered. He finds tin 

 filings, an ounce given daily in an electuary, and followed by a 

 cathartic, to be a certain remedy for cases which depend on 

 the irritation of worms. 1 



ON BLEEDING IN APOPLEXIES 



In the case of apoplexies, Fothergill writes, it is usual for 

 the surgeon, if he finds the pulse full and tense, at once to 

 bleed the patient. It is true that the persons most liable to 

 this disorder are stout, short -necked and inactive, eating 

 freely and often neglecting their evacuations. Bleeding in 

 such persons seems a natural remedy, yet he thinks it is used 

 too often. It might perhaps have prevented the attack and 

 in some cases it may assist recovery by lessening the resistance 

 to the heart's action ; but more frequently the copious drain 

 reduces the strength, and nature's effort at revival is power- 

 fully checked, the patient dying, or if he survives, suffering 

 hemiplegia. 



The common occurrence of a stroke after a plentiful meal 

 suggests to him not so much plethora as that the distended 

 stomach, by pressing on the descending aorta and obstructing 

 respiration, has overfilled the blood-vessels of the head. 

 Instead of bleeding he uses emetics and purgatives, checking 

 faintness by broth or wine, or giving repeated clysters if the 

 patient cannot swallow, with sinapisms to the soles. 



The bearing of a short neck on apoplexy is illustrated by 

 the case of a young plethoric man with a very short neck, who 

 was seized with a brief apoplexy whilst seated in a boat, and 

 turning his head as the boat moved to keep his eye fixed on an 

 object in the river. Fothergill shows that if a leather tube is 



Obs. & Ing. vi. 68 ; Works, iii. 166, 199. Dr. Anthony Fothergill 

 suggested that the slight proportion of arsenic in the tin might be the beneficial 

 agent. Lettsom relates a case of severe juvenile epilepsy, which he attributes 

 to bony spicula? found projecting inwards from the vault of the cranium. 

 Memoirs, iii. 72. 



